Insurance & Financing

Well it's been a long journey just trying how to get in the surgery room. First thought it would be September 28th but ends up tentatively November 8th!

Plz share your experience with Health 1st Medicaid in NY...Thanks

Oh my goodness!!! I got my letter of approval in the mail today. That means Monday they should be calling me to schedule the surgery. I'm soooo excited and scared at the same time!!

Hello Everyone, I will start the process to a better me soon,planning to attend my first seminar on Monday I would like to know if anyone has had surgery at Brooklyn Bariatric? What was your experience?

I am sooooo confused. My insurance is paying for half of my surgery. Ok, I knew this the whole time. This whole 7 month process I was told I would only have to pay a $750 deductible to have the surgery. Surgery is next Monday and now they are saying its $870.00 and I have to pay the surgeon fee before I can have surgery. Is the surgeon fee not included in the procedure cost? How much is an average surgeon fee?

So I have metroplus in ny. My bmi isn't 40 I do not have diabetes nor high blood pressure. I was just told I tested positive for sleep apnea and had to do the 2nd test with the cpap machine. I do have acid reflex and Pcos..I started the doctor process in sept so I'm on my 2nd month. Metroplus requires 6 months of seeing ur MD before they will approve. My question is has anyone been approved with a bmi of less than 40 and just sleep apnea? Was it with metroplus? How long does it take after the 6 month checkup for u to get an approval?

Anyone used BCN MI or M Premiere Care? What was the approval process like? How long did it take? Any snags?

So I have not gone to my 1st consult yet, but I know that I'm just barely above the 35 BMI... I am Hypothyroid and on Meds for that, I also have High BP but I'm not on an Rx for that... Does it still count as a co-morb? Thanks in advance!!

Anyone used BCN MI or M Premiere Care? What was the approval process like? How long did it take? Any snags?

What's your experience with them? They are saying I need preauthorization first before I can start seeing my nutritionist. The doctor said they don't submit anything into the insurance until I'm almost done my nutrition classes? Kinda confused!

We have just added a new page to our site that will give you a complete list of each State and how to contact the proper Insurance Regulatory agency in each State as well as a brief outline of that State's rights. You'll note some States have external reviews, some do not. Each State is different. Here is the link http://www.naic.org/state_web_map.htm click state by state link. Best of luck. Gary Viscio www.ObesityLawyers.Com RNY 7/1/03 -165lbs

Do anyone know of any insurances that will cover the lap band. I already consulted with a surgeon and got all my work up for the procedure. However my insurance will not cover it. My bmi is 40 so I automatically qualify but I am willing to change my insurance at any cost. Then if i do purchase insurance what is the grace period in which i would have to wait? Any suggestions? Next step for me is a loan which I am trying to void

I dont know if this has been discussed here yet, but I wanted to inform you all a Medicare medical review is nearly complete pertaining to official coverage of the VSG. If all goes well, we should have a peliminary decision at the end of this month (3/30/2012)! A final binding decision will be made no later than 6/28/2012. Offical documentation can be found here.... https://www.cms.gov/medicare-coverage-database/details/nca-tracking-sheet.aspx?NCAId=258&fromdb=true I spoke with my Bariatric Surgeons P.A. today and discussed the Medicare coverage review of the VSG. He told me based on his attendance at the annual Bariatric Surgeons convention he was told coverage…

Anyone out there have Ohio BCBS? I attended a bariatric Seminar mid-July in preparation for surgery and found out my group plan excludes bariatric services..of ANY kind, but through self-research discovered that the company itself covers bariatric surgery. Where do I go from here? Does anyone have any experience with this?? I'm at a loss...please help!

Ok so after the first of the year I may have turn purchase insurance thru my work... my question is... if I was to get private insurance effective January 1st.. can I start right away or is there a waiting periods? Anyone have experience with this. I'm not even forsure if it'll be anthem I just know they are looking into it.

I found out today my lapband surgery was Approved...I'm excited and nervous. Calling to find out when my surgery will be scheduled now! Sent from my iPad using LapBandTalk

My company is switching to a new insurance company in January that covers the sleeve. Thing is..they're two plans 1. High Deductible and 2. Buy up plan. Both covers the procedure! Idk which one to pick. The high ded.plan has a 1500 deductible but the buy up deductible is 500. Should I get the buy up but the premium is high..or the cheaper one with high ded. My ins. Is BCBS of WNY.

Hoping someone can might know the answer. I was about as far along as possible last wed. in hospital and literally ready for surgery. My surgeon and the anestig. where speaking with me and my wife when I mentioned that I was having muscle cramps. Due to me being on a statin and the muscle cramps the surgeon felt that this elecvated my risk of complications for surgery so surgery was canceled until this wed. and I was taken off the statin(crestor). Here I am two days away again and I thought I would sail thru past week as I had already had dry run(lol) but has not happened. I can't get out of my mind maybe last week was a sign I should not do this now. I was wondering if…

Hey guys, so the 25th should be the last day of jumping threw hoops for my doctor and he will be submitting my case to Aenta. So was wondering who has Aetna and what was the waiting like? It's taken 3 months to complete everything doctors needed me to do and so I'm praying to get approval on the first try. So questions are how long did it take for your approval, if you were denied, how many attempts did it take to get everything done? Thanks for any feed back, I'm having band removal to sleeve

My insurance does not cover any WLS so i came to terms with that lol. I had gone ahead reached out to Dr.Garcia's office in Mexico I am set to go on Nov 7th. Today I received a call from the one surgeons office that quoted me $23,000 and they mentioned that at one of their other locations the cost would be $11500. That threw a wrench in my plan because for starters I am still scrapping up the money for Mexico, but this one is about $5800 more then me going to Mexico the only thing is I may be able to get on a payment plan here. What to do, what to do? I am not sure if I should stick to my original plan or if I should go and speak with the surgeon to find out about the…

No, I'm not excited at all! Any way I can hardly stay in my skin!

has anyone tried United Medical, I was turned down by Care Credit. Im hoping United Medical will approve me.

I'm hysterical right now. I've got my final PCP visit this afternoon so I called my surgeon's office to find out what documentation they needed from her. Day 90 of this 3 month program is November 15th so I want to make sure everything is in order long before then. My last nutrition and psych/behavioral appts are next Monday. She said the notes from the visits. I asked about the 2 year weight history. I remember reading that I needed documentation that I've been fat for at least 2 years. She said oh yes, notes from 2010 and 2011 also. I said I didn't think there was a note from 2011, but lots from 2010, 2009, 2008, etc. Nope. They will reject it unless it's th…

Does Medicaid pay for gastric sleeve in Connecticut?

I got denied a year ago for lack of information. I had changed drs an she is pretty positive I'm going to get it this time. I have a bmi of 39. She's basically putting in every health issue that's wrong with me. Even headaches..lol. Has anyone had any difficulties with tricare south or maybe some advice. I'm waiting for a call from the surgeon for the first appointment were he puts it into the insurance. I'm super super nervous an can't stop thinking about it.

Has anyone tried this company? Lovin the skin i'm in...

I am excited to share that I received my approval for revision surgery from UHC in less than a week. I completed the 6 month diet requirement along with many other pokes and probes. I will keep you all posted on my surgery date and subsequent progress. Stay encouraged!!

Hi...just wondering if anyone has BCBS of IL.? How were they with approval timing? How long did it take? Just wondering. Thanks for any input you can give.

I am 41 bmi is 34.6... my health ins. Is health America does anyone one know what hoops you have to jump with them... just faxed paperwork to upmc still waiting to here if I'm eligible

I finally got a call back from my insurance company today after waiting for 2 weeks and it is to tell me that they are denying my request because they need proof that I would not be a candidate for gastric bypass before they will cover the sleeve! Is this crazy or is it just me??

I posted in the pre op forum, but i guess i should have posted here sorry for the duplicate post. So my info was submitted to the insurance on Monday and the doctor said that they are needing five years of height and weight information from the doctors. I have BCBS which I have heard usually is an easy approval. I have called my primary care and my ob dr for info and they don't have too much, but they have it about three years back (husband was military moved around a lot prior to that). So the dr said to have this sent over and they will resubmit. Just wondering if this has happened to you all? OBVIOUSLY this has happened with needing extra info with all the hoops t…

I have FED BCBS standard option. Can anyone tell me the difference in costs between standard and basic options? I'm in Ohio but I don't think that makes a difference. Thanks

I am revising to a sleeve. Since I could not afford self pay and cant get insurance I managed to scrape up enough money to get the PCIP insurance ... They will cover revisions.. They did an upper gi and the lady asked me how in the world I was eating ? I told her not very well .My band has so much damage, scar tissue that liquids barely go through my band .. Doc told me there are ppl with band issues and then there is me ! Mine are bad basically . He told me to come back next week for and egd, they stick a tube down my throat to see if my ban d has erroded through my stomach , he suspected it has . Sounds all bad huh ? It is problem no one is in a hurry to get it fixed…

Hello! I am working on getting medical records submitted to my surgeon's office for review. Once received they will let me know what my chances are of getting approved then the pre-op testing will be scheduled. My concern (fear) is the requirement of my insurance company. I meet most of the requirements for approval, however, I've been told that BCBS of WY is very strict as they also require 5 years of medical supervised weight loss. Is this unheard of?!? I've been dieting since I was 8 years old so it's what I'he known. I never asked a doctor for permission each time I went on a diet. Sometimes the insurance companies will accept records from companies such as Weight Wat…

well, last week when I went in for my EGD, my surgeon (Dr. Alok Ghandi) at Rochester General Hospital, told me he heard a rumor that I was approved. I told him it was news to me and that I didn't hear anything. Apparently it only took 48 hours for approval! I never thought it would happen that quick. Especially with no co-morbidities. Then I get home from the procedure and I get the phone call from a case manager of fep BCBS telling me I was approved. They explained all the copays and offered me support both pre-op and post. It is all seeming so real now. I love my insurance company!

Today the bariatric office called and told me, as they were reviewing my labs to submit to insurance company for surgery, THEY CONVIENIENTLY FORGOT TO TELL ME 6 MONTHS AGO that I would need a weight loss summary for a consecutive 2 months written and signed by a doctor!!!!?!!?!?!??!! Where the F$&* am I gonna come up with that in a couple week?!? My insurance ends in October!!!!!!!!!!!!!!!! Theyre sorry?!? Wth do u mean sorry?!? I waisted 6 MONTHS for absolutely nothing!!!! I just wanna cry! No I'm almost positive the surgery will NEVER happen at this point.

My doctor's insurance coordinator emailed me and said it will be another two weeks until we hear from the insurance company. She had to appeal due to my BMI for the past three years being from 38 to 41. All you experienced sleevers, is this the point where I start calling my insurance company everyday? I have documentation for 7 years worth of failed dieting efforts with none of the comorbidities they consider, however, I do have degenerative disc disease and bulging discs as well as planters fasciitis, fibromyalgia and chronic fatigue. Has anyone else been approved with these types of issues on an appeal? I guess I just need an encouraging word right now!

I just finished the old waiting game, 6 month supervised diet, this morning. Now that's done everything is being submitted to the insurance company and we start the new waiting game which is the wait for approval. I'm hoping there won't be any issues. The surgeon says I should have no problem. The insurance coordinator checked everything before we started and we've checked off everything we need. It's always in the back of your mind though that this isn't settled until the insurance company sends you that acceptance letter. If everything works out I'm looking at an October 30th surgery date. Fingers crossed

I have CIGNA as my insurance carrier, so I have the 6 month requirement to go to weight loss classes under a physician's supervision. While this is a bummer because I really want to get going with the lap band surgery and not wait 6 months, I have an additional concern. I am exactly at a BMI of 40. If I lose so much as 10lbs, I won't qualify for the lap band. I am sure I could go to a 6 month supervised clinic and lose 15lbs - and then regain it as soon as I stopped. Or keep it off and continue to struggle being 85lbs overweight instead of 100. Sure, I would love to go to a 6 month thing and lose 50#s and not have to have the lap band, but I've lost 50lbs before onl…

I have united healthcare ppo UMR. Hope all goes well with approval. The coordinator said they are usually good.

I had my last visit on Friday. Faxed all my info to the surgeons office and the ins. Lady says she was submitting it on Friday!?!? So I am just waiting......THIS IS THE HARD PART! How long should I wait before calling BCBS?

How long did it take them to approve once everything was submitted?? I'm anxiously waiting!!!

Ok, so I'm gathering all my documentation showing that I've had a BMI over 40 for the past 5 years. This should be easy considering that I've been over 40 BMI since 2005... However, after I received the records from my Dr's office, I realized that I did not have any weights recorded for the years 2009 and 2011. I have official records from 2005, 2007, 2008, 2010, and 1012. I also have pictures of me for the two missing years but the photographs don't have dates. I was thinking maybe I can show screen shots of the pictures on Facebook showing the dates that they were uploaded, but this is far from an "official record". My little sister graduated in 2011 and I have pic…

I tried all different types of eating disorders back in the day to loose weight. I've since have never considered the thought of doing it again. I even went to a therapist about it a few years ago. Will this hinder me in my approval process from uhc? I'm wondering if I can use my meetings with my therapist as help for my approval? Or if my past eating disorders will hurt me?

I am self pay and have surgery scheduled in November. I have insurance, but have to be bmi of 50 to be covered. I am concerned about complications and those not being covered by insurance? Has anyone had experience with this--I seem to be finding situations where they do cover complications that arise and others where they don't. I have Kaiser Permanente in Oregon. I am wondering if it is better to be proactive and ask membership services if they would cover complications, or just keep my mouth shut and pursue that path if complications do occur? I am confident in my surgeon and his practice, but there are always risks. Thanks for any feedback!

If your BMI is 40 do you not need the last 5 years of weight records? Is it only when your under 40 that you need that?

My documents have been submitted to insurance. So excited but very nervous. They have asked for 2 more reports, which will be submitted on Monday, and then when those are received by them, they will give me an answer within 48 hours. I can hardly breathe I am so afraid the answer is goi g to be no. I don't know how. Will cope if they say no. Please send loads of positive energy this way and pray for a yes. Thanks everyone.

Anyone know about MVP??

Hi, I have a BMI of 35.6 the doctor basically said not to lose any weight until approval. I have blue cross blue shield direct access. I do not have high bp,diabetes, sleep apnea. I do have high cholestrol and osteo arthritis. Did anyone who has a low BMI with no major health issues have any problems getting approved? The doctor does not want me to go to a lower BMI for now in case the insurance does not approve it. Any one else similar to this situation? I live in the beautiful state of NJ

Hello, I am so nervous. I just found this forum, and I am hoping to talk to people who have gone through the same thing. Today is my last weigh in for my 6 months. I have done the 6 month check in, bloodwork, the pre-tests, and nuturician. I have my psych evaluation on the 17th. One month I was up two pounds, stayed the same last month, but will be up 4 pounds today. However, overall I am 14 pounds down even with the gain. I am afraid that aetna will deny me for this, and only having a BMI of 38 and 41 in the past two years. However, I have PCOS and I had to go off my pills for the surgery this made me gain weight. Any advice?